- Part 1 All too often, California’s default mental institutions are now jails and prisons
- Part 2 For families across California, a desperate struggle to get mental health care
- Part 3 Overlooked mental health “catastrophe:” Vanishing board-and-care-homes leave residents with few options
- Part 4 Californians aren’t getting the mental health care they’re legally guaranteed. Why not?
- Part 5 Mental health care outcry targets Kaiser — and state regulators
- Part 6 “We’ve lost our compass.” For California’s most visible mentally ill, is a return to forced treatment a solution — or a false promise?
- Part 7 ‘Go on Medi-Cal to get that’: Why Californians with mental illness are dropping private insurance to get taxpayer-funded treatment
- Part 8 Breakdown: California’s mental health system, explained
Jeffrey Jurgens stood in a cage in an orange jumpsuit, screaming that he was Jesus Christ. From her seat in the Sacramento courtroom, his mother watched through tears.
Joanna Jurgens knew how important it was for the district attorney prosecuting Jeffrey for stealing a car—and the judge deciding his fate—to see the extent of her son’s illness. But it was torture to watch.
For years, she had begged judges to steer Jeffrey, who has schizoaffective disorder, into long-term treatment. She worried he would get hurt. She feared he could hurt someone else.
Joanna, 56, knew Jeffrey, who was 22 at the time of that 2014 hearing, did not belong behind bars. But after struggling to stabilize him through treatment in the community, she’d become convinced the criminal justice system was her last hope.
These days, the main path to treatment at a state psychiatric hospital is through jail. However controversial those state hospitals may be, many families conclude they are the best option for their loved ones.
“That is a sad state of affairs in our society, that only when you get locked up does it become a priority to get you treatment,” said Los Angeles District Attorney Jackie Lacey, who said she’s heard many parents describe similar feelings of desperation.
Perhaps nowhere is California’s mental health crisis more evident than in its criminal justice system. After decades of failure to create and fund policies that effectively help people with serious mental illnesses, many now say the jails and prisons have become the state’s default mental institutions.
Close to a third of California’s inmates have a documented serious mental illness, according to the California Department of Corrections and Rehabilitation.
“We’re going to end up with an incarceration system that’s mainly dealing with people that have serious mental health problems,” said Democratic Sen. Jim Beall of San Jose. “It’s our own fault, in a way, for not having a good mental health system.”
In the past five years, the number of people in California who were deemed incompetent to stand trial after arrest—and ordered sent to state hospitals for treatment—increased by 60 percent, state figures show. Judges make such referrals when doctors determine that defendants are unable to understand legal proceedings or cooperate with their attorneys—the goal generally being that they get stabilized and then return to stand trial.
Often this leaves people who need mental health treatment stuck in county jails. Inmates in Jeffrey’s condition can wait in limbo for months, or even years, before being sent to a state hospital.
Five years ago, an average of 343 inmates with mental illness were awaiting placement. Last year, that number shot up to 819.
The increasing number of people incompetent to stand trial may also reflect changing attitudes among public defenders, who now see questioning someone’s competency as an avenue to a more therapeutic environment, said David Meyer, professor with the USC Institute of Psychiatry, Law, and Behavioral Science. Forty years ago, “we would never, ever refer somebody for incompetency proceedings if we could in any way get away with it,” he said. “People would be incarcerated for mental health treatment at a state hospital for a longer time than they would serve if they simply pled guilty.”
One major reason for the growing waitlist is that, while the number of state hospital beds has increased, it has not kept pace with the need. State hospitals now have more than 6,200 beds—a significant portion of which are reserved for other needs. In recent years the state has added about 700 hospital and “jail-based competency restoration” beds.
A few decades ago, fewer than half of state hospital patients came from the criminal justice system. Today more than 90 percent of them do—with more than a fifth of those individuals found incompetent to stand trial. The next largest group were tried and found not guilty by reason of insanity.
“We have hundreds of people sitting in our (community) hospitals right now who could benefit from a long-term stay at a state hospital, but we can’t get them in there,” said Sheree Lowe, vice president of behavioral health for the California Hospital Association.
That said, many experts believe state hospital stays are so restrictive and expensive that solutions to the crisis must be found elsewhere. The broader issue is that society is “letting people get so sick” that they end up in jails and emergency rooms, Lowe said.
Jennifer Mathis, director of policy and legal advocacy at the Bazelon Center for Mental Health Law, describes state hospitals as “kind of like living in prison.”
“It’s not really a life on a long-term basis,” she said, but added that many families have gone so long without good community mental health services for their loved ones that they see no other real option.
State data show that 47 percent of the inmates who were found incompetent to stand trial last year had no Medi-Cal mental health services during the six months before they landed in jail. Almost half were unsheltered; in many cases, the charges they faced were directly related to their homelessness and untreated psychosis, according to the Department of State Hospitals.
It was not that the system didn’t know them, though. In Napa State Hospital, state data show, nearly half of the people who were incompetent to stand trial had been arrested 15 or more times before they were deemed incompetent.
Joanna Jurgens’ memories of Jeffrey’s childhood—soccer games and fishing trips and visits to the snow—have been obscured by the shadow of his illness. As a little boy, he acted out so much it was hard to keep him in preschool. By middle school, she was receiving daily calls from the principal’s office. Freshman year in high school, he started getting into fights and brought a knife to school.
Unable to control his behavior, Joanna—who operates a clinic for UC Davis Medical Center—and her ex-husband prevailed upon the school district to send their son to a locked residential program in Utah. The structure appeared to help. But after nine months, she said, he returned home, and the same behaviors resurfaced.
That Thanksgiving, when Jeffrey was 17, his mother drove him to his grandmother’s house in Tahoe. He couldn’t stop obsessing about a white car he thought was trailing them, which he insisted carried either government agents or the CIA.
Joanna took him to psychiatrist after psychiatrist. They put him on mood stabilizers and, eventually, anti-psychotics. He continued to spiral. Marijuana made the symptoms worse. He stole Joanna’s car again and again. Then, at 19, Jeffrey stole a friend’s parents’ car. They pressed charges.
“He needs help and I don’t know what to do,” Joanna remembers telling an El Dorado County judge around 2010. “We’re waiting for a disaster to happen.”
The judge was sympathetic, but told Joanna his hands were tied. He sent Jeffrey to jail for 90 days. After he got out, Jeffrey was on and off the streets, lost in a haze of street drugs and psychosis.
Over and over, he’d land in psychiatric hospitals. But each time he’d stabilize after a few weeks and his insurance provider would insist he be discharged, Joanna said. Joanna was certain her son needed longer-term inpatient treatment. She begged doctors to put him under a conservatorship, allowing a legal guardian to make decisions on his behalf.
A doctor who saw him at Sierra Vista Hospital in Sacramento agreed with her, Joanna said. Jeffrey spent six weeks there while the doctor pushed for him to be conserved. The county refused—Joanna remembers being told that Jeffrey needed to fail out of community treatment once more to be eligible.
Michelle Lazark, who at the time worked on the Sacramento Police Department’s mobile crisis unit, remembered the first time she came upon the disheveled-looking young man wearing tattered clothes and no shoes.
“Are you a new guy?” she asked. Jeffrey told her his name. Lazark asked if she could call his mom.
“Oh my God,” Joanna said after she picked up the phone. “Where did you find him?”
Over the years, Lazark would often help Joanna search for Jeffrey. Sometimes he was relatively lucid, and she’d share her sandwich with him and chat. Other times she took him to the hospital. If he was self-medicating with meth, she’d take him to jail for a few hours to sober up.
“You want to protect them and you want to take them to a safe place where they can detox,” Lazark said. “If that was jail, then that’s what I would do every time. It’s not criminalizing it, it’s keeping them safe.”
But not all interactions with law enforcement went well.
In 2012, two CHP officers saw him driving a stolen car the wrong way down a one-way street in Sacramento. After a high-speed chase, he came to a stop. A lawsuit filed by the family in federal court said that although he was unarmed and had raised his hands, officers began kicking and beating him with their batons, leaving him with a broken hand and a traumatic brain injury—and then high-fived each other.
After an in-car camera video of the incident came out, the district attorney dropped charges against Jeffrey. Last spring, Jeffrey received a million-dollar settlement. (The officers involved all remain employed by the CHP).
The day he was discharged from jail, Jeffrey disappeared back into homelessness, said his attorney, Beau Weiner. Months later, on December 5, 2013, he stole a car from valet parking in downtown Sacramento and was peacefully apprehended.
Twice a week, his mother visited him in jail.
“I see you in here a lot,” she remembers a security officer telling her one day.
“I visit my son,” she said.
“He probably doesn’t deserve it,” the officer said.
Joanna Jurgens looked at him sadly. Why bother trying to explain?
“You don’t know the whole situation,” she said.
Because their mental illness leaves them so vulnerable, inmates in that condition are often kept in solitary confinement for their own protection. But extended stays in solitary exacerbate their mental illnesses, too.
“You put a bird in a cage, you got to let him out sometime, or he’ll die,” says Samuel Mays, whose adult son, Lorenzo, has been in Sacramento County Jail for eight years waiting to be declared competent. Lorenzo Mays, who has cognitive delays as well as mental illness, is the lead plaintiff in a class action complaint being brought by Disability Rights California against Sacramento County. The complaint cites overcrowding, understaffing and “dangerous, inhumane and degrading conditions,” including use of extended solitary confinement on inmates with serious mental illness.
“He’s suffering,” Samuel Mays said of his son. “You can only take so much of that.”
Douglas Clark, who landed in jail on an attempted burglary charge in 2009, picked up a new charge in prison after throwing feces at a correctional officer. Clark, who has schizophrenia and hears spirits talking to him, was found incompetent to stand trial, said his mother Tammy Clark. He was sent to regain competency at the state hospital. He returned to jail to be tried, she said, but went off his medication, or had it changed, and then became mentally unstable again. That cycle keeps repeating, she said.
She tries not to seem upset when she talks to him—she wants to be “a light” in his dark world.
But sometimes he can tell she’s been crying.
“It’s so disheartening,” she said.
Even as the population of inmates with mental illness burgeons, some advocates see the beginning signs of hope.
Sen. Beall, who himself has a family member with schizoaffective disorder, said the administrations of former governors Arnold Schwarzenegger and Jerry Brown rebuffed policy proposals meant to make comprehensive mental health services available in the community.
But last year, Brown signed a provision to allow courts to divert certain offenders with mental illness into community-based inpatient or outpatient treatment programs, and another to reduce the maximum wait time for an inmate to become competent to stand trial—from three years to two.
Last month, Gov. Gavin Newsom proposed a state budget that includes tens of millions of dollars for mental health programs, including training law enforcement officers on crisis de-escalation. The budget would also provide one-time grants to treat young people experiencing early psychosis and $100 million for “whole person care” programs that seek to address the housing, health, mental health and substance abuse needs of people experiencing homelessness.
Judge Stephen Manley started one of the nation’s first mental health courts in Santa Clara County more than 20 years ago. In these courts, public defenders, prosecutors, judges and social service providers work together to connect people with mental illness who have been arrested for certain crimes with services and treatment, with a goal of keeping them out of jail.
“Everyone wants to tell me, ‘It’s so complex, we can’t solve it.’” Manley said. “And I say, ‘No, you can. Get together and figure out what you can do.’”
Over the years, the model has expanded to counties around California.
On a recent afternoon in Department 8 in the downtown Sacramento courthouse, Judge Lawrence Brown called up the mental health court participants one by one. He complimented a woman’s red hat, another man’s poncho. He ribbed those who had a lot of hair, contrasting it with his own balding pate.
Standing alongside their public defenders, some participants beamed as he lauded their progress staying on medications and off drugs, getting jobs and doing their dishes. Others squirmed uncomfortably in the spotlight. One woman’s voice cracked as she described her troubled relationship with her mother.
“The fact that you’re taking all of these steps to take care of yourself, we’re behind you a thousand percent,” the judge told her.
Brown, who has run the county’s mental health court since 2013 and has helped it to expand, says he’s been drawn to the work because of the “humanity of it all.”
“Keeping them in jail once they’re back on their medication is not a very compassionate approach,” he said. “They’re living a nightmare being behind bars. That setting of being in a cell, with loud noises, is not an opportune manner in which to address serious mental illness.”
For now, though, such courts still only serve a fraction of the ballooning need. Sex offenders, arson registrants, active gang members, those who have caused great bodily injury or death, and those arrested for driving under the influence are among those who are typically excluded. And many such courts aren’t designed to serve those who are incompetent to stand trial.
Jeffrey Jurgens doesn’t remember much about the months he waited in jail to get a bed at Atascadero State Hospital—one of the five state hospitals that house people with serious mental illness. Reached over the phone there, Jurgens, now 27, said at first only that being in jail “doesn’t feel too good.”
After his mother prompted him, he recalled being periodically locked in solitary confinement the Sacramento County Jail after he was arrested in December 2013, alone with the voices, emerging—in her memory—for just an hour every couple of days.
“It was a bummer,” he said quietly. “I was going a little stir crazy. I didn’t know what to do, what to think. Nobody would help me while I was there. They just pushed me off because I wasn’t like everyone else.”
His mother figures it’s good he doesn’t remember more. Because she does.
She remembers the day he called her, panicked, after his heavyset new cellmate kept trying to give him bear hugs. She remembers him whispering into the phone: “I’m really scared.” With Lazark’s help, she got him moved.
Joanna also remembers the night Jeffrey called her, agitated and delusional. She was so terrified of what he might do to himself or someone else that she raced to the jail and refused to leave until she spoke to a sergeant.
After Jeffrey was arrested for stealing the car from the valet, weeks passed before he appeared before the judge, screaming that he was Jesus. In February 2014, he was admitted to a state hospital.
At the end of August, after six months of receiving treatment and preparing for a court appearance, he was found competent enough to have a trial. Months later, in May 2015, he was found not guilty by reason of insanity. He returned to Atascadero State Hospital that June. Someday he hopes he’ll be well enough to get out, so he can spend time with his family and get a job at a grocery store.
Joanna wishes her son had received intensive treatment earlier.
It troubles her to think about all the other inmates like him, stuck behind bars with no one to speak up for them.
“You’ve got to fight,” she said. “If somebody doesn’t have someone to advocate for them, they don’t stand a chance. They don’t stand a chance.”
The Breakdown: Mental Health series is supported by a grant from the California Health Care Foundation.
Breakdown: Mental health in California
- Part 1 All too often, California’s default mental institutions are now jails and prisons In the past five years, the number of people in California deemed incompetent to stand trial and referred by a judge to state hospitals for treatment has soared—but there are nowhere near enough psychiatric beds to accommodate them.
- Next: Part 2 For families across California, a desperate struggle to get mental health care Californians with mental illness—and their family members—describe pleading with insurance providers for the treatment they need.
- Part 3 Overlooked mental health “catastrophe:” Vanishing board-and-care-homes leave residents with few options Housing costs have forced many board-and-care homes to shutter. Mental health advocates say the closures will exacerbate the homeless crisis in California.
- Part 4 Californians aren’t getting the mental health care they’re legally guaranteed. Why not? Laws require health plans to provide patients equal treatment for mental and physical needs. But "parity" is often elusive — and critics say the Legislature and health officials have failed to fix the problem.
- Part 5 Mental health care outcry targets Kaiser — and state regulators Striking clinicians — spotlighting complaints that patients with serious mental illness face long waits and inadequate care — lay blame at the doorstep of the state Department of Managed Health Care.
- Part 6 “We’ve lost our compass.” For California’s most visible mentally ill, is a return to forced treatment a solution — or a false promise? California inches toward making it easier to compel treatment for mental illness, but serious questions remain. Among them: Do treatment options even exist?
- Part 7 ‘Go on Medi-Cal to get that’: Why Californians with mental illness are dropping private insurance to get taxpayer-funded treatment It may be an agonizing decision — but the only way to get care their insurance won't cover.
- Part 8 Breakdown: California’s mental health system, explained